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Original Research
Effects of Bariatric Surgery in Early- and Adult-Onset Obesity in the Prospective Controlled Swedish Obese Subjects Study
Felipe M. Kristensson, Johanna C. Andersson-Assarsson, Per-Arne Svensson, Björn Carlsson, Markku Peltonen, Lena M.S. Carlsson
Diabetes Care 2020 Jan; dc191909. https://doi.org/10.2337/dc19-1909
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Abstract

OBJECTIVE Bariatric surgery is an effective treatment for obesity, but it is unknown if outcomes differ between adults with early- versus adult-onset obesity. We investigated how obesity status at 20 years of age affects outcomes after bariatric surgery later in life.

RESEARCH DESIGN AND METHODS The Swedish Obese Subjects study is a prospective matched study performed at 25 surgical departments and 480 primary health care centers. Participants aged 37–60 years with BMI ≥34 kg/m2 (men) or ≥38 kg/m2 (women) were recruited between 1987 and 2001; 2,007 participants received bariatric surgery and 2,040 usual care. Self-reported body weight at 20 years of age was used to stratify patients into subgroups with normal BMI (<25 kg/m2), overweight (BMI 25–29.9 kg/m2), or obesity (BMI ≥30 kg/m2). Body weight, energy intake, and type 2 diabetes status were examined over 10 years, and incidence of cardiovascular and microvascular disease was determined over up to 26 years using data from health registers.

RESULTS There were small but statistically significant differences in reduction of body weight among the subgroups after bariatric surgery (interaction P = 0.032), with the largest reductions among those with obesity aged 20 years. Bariatric surgery increased type 2 diabetes remission (odds ratios 4.51, 4.90, and 5.58 in subgroups with normal BMI, overweight, or obesity at 20 years of age, respectively; interaction P = 0.951), reduced type 2 diabetes incidence (odds ratios 0.15, 0.13, and 0.15, respectively; interaction P = 0.972), and reduced microvascular complications independent of obesity status at 20 years of age (interaction P = 0.650). The association between bariatric surgery and cardiovascular disease was similar in the subgroups (interaction P = 0.674). Surgical complications were similar in the subgroups.

CONCLUSIONS The treatment benefits of bariatric surgery in adults are similar regardless of obesity status at 20 years of age.

Footnotes

  • This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc19-1909/-/DC1.

  • Received September 25, 2019.
  • Accepted January 1, 2020.
  • © 2020 by the American Diabetes Association.
http://www.diabetesjournals.org/content/license

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.

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Effects of Bariatric Surgery in Early- and Adult-Onset Obesity in the Prospective Controlled Swedish Obese Subjects Study
Felipe M. Kristensson, Johanna C. Andersson-Assarsson, Per-Arne Svensson, Björn Carlsson, Markku Peltonen, Lena M.S. Carlsson
Diabetes Care Jan 2020, dc191909; DOI: 10.2337/dc19-1909

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Effects of Bariatric Surgery in Early- and Adult-Onset Obesity in the Prospective Controlled Swedish Obese Subjects Study
Felipe M. Kristensson, Johanna C. Andersson-Assarsson, Per-Arne Svensson, Björn Carlsson, Markku Peltonen, Lena M.S. Carlsson
Diabetes Care Jan 2020, dc191909; DOI: 10.2337/dc19-1909
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© 2021 by the American Diabetes Association. Diabetes Care Print ISSN: 0149-5992, Online ISSN: 1935-5548.